Justia Insurance Law Opinion Summaries

Several insurance companies participate in Indiana’s Assigned Risk Plan, a statutory system designed to ensure workers’ compensation coverage for employers unable to obtain insurance in the voluntary market. One participating insurer, Technology Insurance Company, provided coverage under this system. After handling a significant workers’ compensation claim and settling for over $2 million, the company sought reimbursement from the Indiana Compensation Rating Bureau, as provided in their agreements. The Bureau denied reimbursement, alleging the company had acted fraudulently. The company followed the dispute-resolution procedures required by contract, ultimately securing a favorable ruling from an administrative law judge, who ordered full reimbursement. The company then sought additional relief—attorneys’ fees, interest, and expenses—from the agency, but received no response despite repeated requests.After payment of the principal settlement amount but no fees or interest, the company sought judicial review in the Marion Superior Court, which found the Department of Insurance’s failure to rule was arbitrary and contrary to law. The trial court ordered the Bureau to pay fees, interest, and expenses. The Bureau appealed, and the Indiana Court of Appeals reversed, holding the company’s claims for fees were not governed by the parties’ agreements and must be presented anew to the Bureau.The Indiana Supreme Court granted transfer, vacating the appellate court’s decision. The Court held that the company was required to exhaust administrative remedies, as set out in the Assigned Risk Plan and related agreements, but found the company had done so by pursuing its claims through the prescribed channels. The Court further held that the company was entitled to prejudgment interest, attorneys’ fees, and expenses under the contracts, and that these collateral claims could properly be added in the judicial review proceedings without further agency exhaustion. The judgment for the company was affirmed and the case remanded to the trial court for calculation and award of appropriate fees, interest, and expenses. View "Indiana Compensation Rating Bureau v. Technology Insurance Company" on Justia Law

Toy Quest Ltd. purchased an insurance policy from General Star Indemnity Company, which covered personal injury claims arising from certain specified torts, including malicious prosecution. When ASI, Inc. sued Toy Quest in federal district court in Minnesota for abuse of process, General Star agreed to defend Toy Quest under a reservation of rights but then filed a separate lawsuit seeking a declaratory judgment that it had no duty to defend against ASI’s claim. Toy Quest and ASI contended that the policy covered abuse of process, that California rather than Minnesota law should apply, and that the court should abstain from deciding the case until the underlying litigation was resolved.The United States District Court for the District of Minnesota granted General Star’s motion for judgment on the pleadings, holding that the policy did not cover abuse of process claims and that Minnesota law applied. The court also declined to abstain from hearing the declaratory judgment action and denied Toy Quest’s motions to certify the coverage issue to the Minnesota Supreme Court and to disqualify ASI’s counsel. Toy Quest and ASI appealed these rulings.The United States Court of Appeals for the Eighth Circuit affirmed the district court’s judgment. The court held that the district court did not abuse its discretion in declining to abstain, as the cases were not parallel and the federal court had jurisdiction. It further held that the insurance policy’s express coverage for malicious prosecution did not extend to abuse of process claims, as these are distinct torts under Minnesota law, and similar reasoning would apply under California law. The court also held that there was no actual conflict of law and denied the motions to certify and to disqualify counsel. View "General Star Indemnity Company v. ASI, Inc." on Justia Law

An individual purchased a long-term care insurance policy that covered expenses incurred at nursing or assisted living facilities. During the COVID-19 pandemic, at age 94, the insured fractured her hip and, due to concerns about contracting COVID-19 in a communal setting, received post-surgical care at home as prescribed by her physician. When she submitted a claim for these home health care expenses, the insurance company denied coverage, stating that her policy did not include home care benefits. The insured had selected a policy that covered only institutional care, though an alternative plan of care provision allowed for non-institutional benefits if certain conditions were met, including mutual agreement between the insured, her provider, and the insurer.The insured, through her successor trustees, filed a breach of contract action in the United States District Court for the Northern District of Illinois, Eastern Division. Both parties moved for summary judgment. The district court found in favor of the insurer, holding that the policy did not provide home health care benefits, and that the denial of coverage under the alternative plan of care provision was not in bad faith because the insured had not met the necessary conditions to trigger that provision.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the grant of summary judgment de novo. The court held that the policy did not provide for home health care benefits, as required for the relevant Illinois insurance regulation to apply. The court also determined that the alternative plan of care provision was discretionary and did not guarantee coverage for home care. Additionally, the insurer did not breach the implied covenant of good faith and fair dealing by enforcing the explicit terms of the policy. The Seventh Circuit affirmed the district court’s judgment. View "Hartnett v Jackson National Life Insurance Company" on Justia Law

A group of workers was injured in a workplace accident at a South Texas refinery when a fire-suppression system, supplied and programmed by Scallon Controls, Inc., unexpectedly discharged after losing power. The workers sued S&B Engineers & Constructors, Ltd. and Sunoco Logistics Partners, the companies responsible for the project. S&B and Sunoco then brought third-party claims against Scallon, alleging breach of contract and seeking indemnification under their agreement, which included a proportional indemnity provision. Following four years of litigation, S&B and Sunoco settled with the injured workers, fully resolving the tort claims. S&B and its insurer, Zurich American Insurance Company, subsequently sought to recover from Scallon a proportional share of the settlement, corresponding to Scallon’s alleged share of fault.The trial court granted summary judgment for Scallon, and the Court of Appeals for the Ninth District of Texas affirmed, relying on prior Supreme Court of Texas decisions, notably Beech Aircraft Corp. v. Jinkins and Ethyl Corp. v. Daniel Construction Co. The appellate court held that S&B and Zurich could not maintain an indemnity claim after settling, and that Zurich’s claim was time-barred.The Supreme Court of Texas reversed, holding that neither Jinkins nor Ethyl precludes enforcement of a freely negotiated, proportional indemnification agreement after settlement. The Court clarified that such contracts are distinct from common law or statutory contribution rights and that parties may contract for comparative indemnity, so long as the contract does not require indemnification for the indemnitee’s own negligence unless stated with specific language. The Court also held that Zurich’s claim was timely, as the limitations period began to run at settlement. The case was remanded to the trial court to determine whether S&B and Zurich can establish Scallon’s proportional liability and the reasonableness of the settlement. View "S&B ENGINEERS & CONSTRUCTORS, LTD. v. SCALLON CONTROLS, INC." on Justia Law

The case concerns an individual who was injured in an automobile accident while driving a car borrowed from a friend without seeking or obtaining permission. The driver did not have a valid license or insurance at the time. After the accident, she applied for personal protection insurance (PIP) benefits through the Michigan Assigned Claims Plan, and her claim was assigned to an insurer, which denied coverage. The insurer argued that her claim was barred under MCL 500.3113(a) because the vehicle was allegedly taken unlawfully and she did not have a reasonable belief that she had permission to use it.The Wayne Circuit Court denied the insurer’s motion for summary disposition and denied reconsideration. On appeal, the Michigan Court of Appeals reversed, concluding that the driver was not entitled to PIP benefits because her lack of a valid driver’s license meant she was unlawfully operating the vehicle at the time of the accident. The appellate court found that, since operating without a license is a criminal offense, this constituted an unlawful taking under the relevant statute.The Supreme Court of Michigan reviewed the decision and held that the appellate court misinterpreted MCL 500.3113(a). The Supreme Court clarified that the statute bars PIP benefits only if the vehicle was “taken unlawfully,” which is distinct from being “operated unlawfully.” The focus should be on how possession of the vehicle was gained, not on unlawful operation, such as driving without a license. The Supreme Court reversed the appellate court’s ruling and remanded the case for further proceedings to consider whether the driver’s actions constituted an unlawful taking of the vehicle, as opposed to unlawful operation. View "Swoope v. Citizens Insurance Co Of The Midwest" on Justia Law

Hurricane Ida struck Louisiana on August 29, 2021, causing damage to property insured by Capitol Preferred Insurance Company, which had merged with Southern Fidelity Insurance Company (SFIC). The named insured was Emma Bryan, and the plaintiffs—Cynthia Bryan, Aubry Bryan, Jr., Aunya Bryan, and Glenda Bryan—sought policy proceeds. The insurance policy required that any action be brought within two years of the date of loss. SFIC made an unconditional payment to the plaintiffs on March 1, 2022. On June 15, 2022, SFIC was placed into receivership and declared insolvent. Plaintiffs initially sued Louisiana Citizens Property Insurance Corporation (LCPIC) but amended their petition on October 24, 2023, to substitute the Louisiana Insurance Guaranty Association (LIGA) as the defendant.The trial court denied LIGA’s peremptory exception of prescription. LIGA then sought supervisory review from the Louisiana Court of Appeal, Fourth Circuit. The appellate court held, in a four-to-one decision, that the two-year limitation for suit against LIGA began on the date of SFIC’s insolvency, not the date of loss, and denied LIGA relief. One judge dissented, maintaining that prescription should run from the date of loss.The Supreme Court of Louisiana reviewed the matter. It held that LIGA is entitled to the benefit of the policy’s two-year prescriptive period, but this period is subject to interruption by an unconditional payment. The Court found that SFIC’s unconditional payment on March 1, 2022, interrupted prescription, and the plaintiffs’ amended petition was timely. The Court clarified that only unconditional payments—those made without qualifications or reservation of rights—interrupt prescription. The Supreme Court of Louisiana affirmed the denial of LIGA’s exception of prescription and remanded the case for further proceedings in the trial court. View "BRYAN VS. LOUISIANA CITIZENS PROPERTY INSURANCE CORPORATION" on Justia Law

A family visiting Arkansas stopped at the Lydalisk Bridge, a low-water crossing over the Middle Fork of the Little Red River. The bridge, owned by The Nature Conservancy, created a pool upstream where water flowed through narrow culverts beneath the bridge. There were no warning signs posted. A seven-year-old child swam in the pool and was pulled by the river’s current into a culvert, becoming trapped and subsequently dying. The Nature Conservancy had commissioned engineering reports about this and a similar nearby bridge, but received the report warning of risks at the Lydalisk Bridge only after the incident.The United States District Court for the Eastern District of Arkansas reviewed the parents’ negligence and malicious failure-to-warn claims against The Nature Conservancy and its insurers. The district court granted the defendants’ motions to dismiss. The court found that the Arkansas Recreational Use Statute (ARUS) generally relieves landowners from a duty of care to recreational users, unless there is a malicious failure to warn of an ultra-hazardous condition actually known to the owner. The court held that the complaint’s allegations did not plausibly show malice, only recklessness. The court also found that the Arkansas Direct-Action Statute (DAS) did not allow direct suit against the insurers, because The Nature Conservancy was not immune from suit—only from liability.On appeal, the United States Court of Appeals for the Eighth Circuit affirmed. The Eighth Circuit held that, under ARUS, Allen’s allegations did not satisfy the requirement for malicious conduct, and thus he failed to state a claim for breach of duty. The court further held that ARUS provides immunity from liability but not from suit, making DAS inapplicable to the insurers. The dismissal by the district court was affirmed. View "Allen v. Nature Conservancy" on Justia Law

A resident of Puerto Rico suffered work-related injuries in 1994, resulting in permanent total disability. His employer and its insurance carrier were ordered to provide medical care under Section 7 of the Longshore and Harbor Workers’ Compensation Act, as extended by the Defense Base Act. In 2019, a Puerto Rico-licensed physician recommended medical cannabis-infused edibles to treat the petitioner’s chronic pain. The petitioner sought reimbursement for these products from the employer’s insurance carrier, which denied the request.The petitioner then asked the United States Department of Labor’s Office of Administrative Law Judges to order reimbursement, arguing that medical cannabis was a reasonable and necessary treatment. The Administrative Law Judge denied the request, finding that marijuana’s classification as a Schedule I substance under the Controlled Substances Act (CSA) meant it could not have an accepted medical use under federal law. On appeal, the Department of Labor Benefits Review Board affirmed this decision by a 2-1 vote, agreeing that reimbursement was barred by the CSA and rejecting arguments that recent federal appropriations riders or executive actions altered the federal legal status of marijuana.On further appeal, the United States Court of Appeals for the Second Circuit reviewed the case. The court held that because marijuana remains a Schedule I substance under the CSA, it cannot be considered a reasonable and necessary medical expense for purposes of reimbursement under the Longshore and Harbor Workers’ Compensation Act. The court found that neither appropriations riders nor recent executive or legislative actions had changed marijuana’s federal classification or its legal status under the Act. Therefore, the court denied the petition for review. View "Garcia v. Department of Labor" on Justia Law

This case arises from multi-district litigation involving claims that certain aqueous film-forming foam products caused injuries, and that Illinois Union Insurance Company issued excess liability policies to BASF Corporation, which allegedly designed and sold components of those products. Plaintiffs, who originally filed their cases in Wisconsin state court, assert that Illinois Union is directly liable under Wisconsin law for BASF’s conduct. After removal to federal court, the cases were consolidated for pretrial proceedings in the United States District Court for the District of South Carolina under the multi-district litigation statute.The District Court for the District of South Carolina, managing the consolidated proceedings, had entered case management orders requiring motions either to be signed by lead counsel or, if not, to be preceded by a motion for leave of court. Illinois Union sought leave to file a motion to stay the proceedings against it pending arbitration, contending that its insurance policies required arbitration of the dispute. The district court denied Illinois Union’s motion for leave, first citing a failure to consult with lead counsel as required, but then acknowledging that consultation had ultimately occurred. The decisive reason for denial was that lead counsel did not consent to Illinois Union’s motion, and the district court ruled that, absent such consent, the motion could not be filed.The United States Court of Appeals for the Fourth Circuit reviewed the district court’s order. It held that, while district courts have broad discretion to manage multi-district litigation, they may not exercise this authority in a way that prevents a party from asserting its statutory right under the Federal Arbitration Act to seek a stay of litigation pending arbitration. Because the district court’s order effectively barred Illinois Union from filing its stay motion based on lack of lead counsel’s consent, the Fourth Circuit vacated the district court’s order and remanded for further proceedings. View "Bouvet v. Illinois Union Insurance Company" on Justia Law

A fire severely damaged a church building in southeastern Indiana. The church promptly notified its insurer, which had issued a policy covering actual cash value (subject to depreciation) and additional replacement-cost benefits if the property was repaired or replaced “as soon as reasonably possible.” The parties disputed the cost of rebuilding, but the insurer paid the church nearly $1.7 million—the undisputed actual cash value and additional agreed amounts—while the church continued to contest the estimates and did not begin repairs or replacement. About two years after the fire, the church sued the insurer for breach of contract and bad faith denial of replacement-cost benefits.The insurer removed the case to the United States District Court for the Southern District of Indiana and moved for summary judgment, arguing that the church had not complied with the policy’s requirement to repair or replace the property promptly. The church, represented by counsel, responded with arguments about factual disputes over estimates and the credibility of insurance adjusters, but did not address the legal basis concerning the contractual precondition for replacement-cost benefits. The district court granted summary judgment to the insurer, finding the church had failed to engage with the insurer’s core argument.On appeal, with new counsel, the church raised for the first time that ongoing disputes over replacement-cost estimates excused its failure to begin repairs, citing two Indiana Court of Appeals cases. The United States Court of Appeals for the Seventh Circuit held that this argument was waived because it was not presented to the district court. The Seventh Circuit further held that plain-error review in civil cases is available only in extraordinary circumstances not present here. The court affirmed the district court’s judgment in favor of the insurer. View "Crothersville Lighthouse Tabernacle Church v. Church Mutual Insurance Company" on Justia Law